Concurrent Chemoradiotherapy for Men With Locally Advanced Penile Squamous Cell Carcinoma

Chemoradiotherapy is often administered for locally advanced penile squamous cell carcinoma (PSCC), an orphan malignancy, but outcomes with this approach are unclear. This retrospective analysis of 26 patients reports outcomes with concurrent chemoradiotherapy for locally advanced and advanced PSCC. The study highlights dismal outcomes with chemoradiotherapy and suggests the need for better understanding of tumor biology and evaluation of novel systemic agents. Background: Outcomes with concurrent chemoradiotherapy for penile squamous cell carcinoma (PSCC) are unclear, and only anecdotal reports have been published. This study was a retrospective analysis of patients who received concurrent chemotherapy and radiotherapy for PSCC. Patients and Methods: Individual patient-level data were obtained from 5 institutions for outcomes with concurrent chemoradiotherapy for PSCC. Descriptive statistics were calculated, and univariable Cox proportional hazards regression analysis was conducted to examine the prognostic effect of candidate factors on progression-free survival (PFS) and overall survival (OS). Results: A total of 26 men were evaluable. The mean age was 60.3 years. The clinical stage was <= III in 9 patients (36%) and stage IV in the rest. Soft tissue and visceral metastasis were present in 35% and 20% of patients, respectively. The chemotherapy was cisplatin-based in 92.3% of patients, and the median (range) of external beam radiotherapy administered was 4900 cGy (range, 1800-7000 cGy). The median OS was 6.9 months (95% CI, 5-14), and the median PFS was 5.1 months (95% CI, 2.5-7.0). When excluding patients with M1 disease, the remaining patients (n = 21) had a median OS and PFS of 10.0 months (95% CI, 5-14) and 6.0 months (95% CI, 2.0-7.0), respectively. Baseline neutrophil to lymphocyte ratio (NLR) was significantly associated with survival, and visceral metastasis showed a trend for association with OS. Conclusions: Concurrent chemoradiotherapy demonstrated poor outcomes for locally advanced PSCC. Better understanding of tumor biology and study of novel combinations of biologic agents with radiation are warranted. (C) 2014 Elsevier Inc. All rights reserved.